Latest news with #TheAgeofDiagnosis
The Guardian
30-04-2025
- Health
- The Guardian
The experts: neurologists on 17 simple ways to look after your brain
As we live longer, our risk of cognitive impairment is increasing. How can we delay the onset of symptoms? Do we have to give up every indulgence or can small changes make a difference? We asked neurologists for tips on how to keep our brains healthy for life. 'All of the sensible things that apply to bodily health apply to brain health,' says Dr Suzanne O'Sullivan, a consultant in neurology at the National Hospital for Neurology and Neurosurgery in London, and the author of The Age of Diagnosis. 'When you're 20, you can get away with absolute murder. You can not sleep for nights at a time and stuff like that. But you get away with nothing when you hit middle age. With every year that I get older, my lifestyle gets healthier.' All of her consultations will focus to some degree on lifestyle choices, she says: 'I work with a lot of people with degenerative brain diseases, and they are not caused by lifestyle. But everything is made better by having a moderate degree of exercise, eating healthily and sleeping well, whether it be bodily disease, brain disease or mental health.' 'If you want to damage your brain, smoke a lot,' says Tom Solomon, professor of neurology at the University of Liverpool. Likewise, 'a lot of alcohol is not good for you. A bit of alcohol seems to be OK. There is some soft data suggesting one to two units might reduce risks of cardiac disease in the elderly, but the evidence overall is that alcohol is harmful, especially to the brain.' Dr Faye Begeti, a neurologist and neuroscientist at Oxford University hospitals, takes a hard line: 'I find that people who are not alcoholics, but drink a small amount of alcohol every day over many decades, can still run into problems. With alcohol I have two rules for my patients: not out of habit, so only when celebrating; and not drinking daily.' There is a well-established link between physical activity and brain health, says Dr Richard Davenport, a consultant neurologist in Edinburgh and the outgoing president of the Association of British Neurologists: 'It works on many levels: psychological, metabolic, physiological.' 'Things that are good for your blood vessels are good for your brain,' Solomon says. 'A lot of dementia is because of damaged blood vessels. Physical activity is good for blood vessels as it keeps blood pressure down.' Solomon got a Guinness world record for running the fastest marathon dressed as a doctor in 2010, raising money for Encephalitis International, a brain inflammation charity. But you don't need to run marathons to keep your brain healthy, he says. Although, 'there is not much hard data telling you exactly how much exercise to do – in our headache clinics we say do 20-30 minutes of something that gets you at least a little bit short of breath two or three times a week, so running, swimming, cycling. They are very good for de-stressing, too,' he adds – another bonus for the brain. 'There are studies that show being active in every decade really helps with brain longevity,' says Begeti. 'I advise people to include single-leg exercises in their routine, because walking relies heavily on single-leg balance, and maintaining this becomes crucial as we get older. Aerobic exercise releases a brain-nourishing chemical called brain-derived neurotrophic factor that supports our neurons. A combination of that with resistance exercises that build up muscle is very important, as numerous studies have found greater muscle mass reduces cognitive decline, even in those who have already been diagnosed with dementia.' Opt for 'antioxidants and unsaturated fats, and not too much red meat', says Solomon. 'The biggest evidence is for the Mediterranean diet,' says Begeti, adding: 'I was born in Greece, so maybe I am biased.' She says the advice she often gives on this is simple: 'When you cook, your primary source of fat should be olive oil rather than butter. This is what I do and it is a really easy transition to make. You can have cakes with olive oil in; everything you fry should be in olive oil, rather than butter. I'm not saying you would never eat butter again, but that the primary source of fat is olive oil. And having some omega-3 with oily fish has really good evidence for brain health as well.' She says it is important for vegans and vegetarians to take vitamin B12 supplements. 'We see people who have simple or chronic headaches,' says Solomon. 'The things that reduce the risk of headaches are all very much the same. Regular exercise. Staying hydrated by drinking at least two litres of water a day. Stopping all caffeine. Not skipping meals. Getting to bed at a sensible time. We usually say to people: if you do this religiously for three months, headaches will reduce or come under control. And most of those things are also good for your general brain health, as far as we know.' 'Good sleep starts at the beginning of the day,' says Begeti, 'rather than at night when you are stressing about not getting good sleep. Anchor your morning by getting up at roughly the same time each day. If you need more sleep at the weekends, then catch up with 60 to 90 minutes, or one sleep cycle extra. Don't make it too erratic, because then your brain doesn't know when to produce the right hormones.' 'We still don't exactly know what sleep is all about,' says Davenport, 'but increasingly, there is good evidence that sleep is allowing the brain some downtime to do a bit of tidying up, and in particular, tidying some of these dodgy proteins that ultimately may do bad things in terms of degenerative disease. In other words, getting decent sleep matters.' 'With insomnia, there can be a lot of worry when we hear that reduced sleep can give rise to disease,' says Begeti. 'I think it is about being able to do good things for your brain, but not being really stressed if you're not doing everything perfectly, because stress has really negative effects as well.' But, she concedes: 'It's easier said than done to say to somebody, 'Don't be stressed!'' 'There is evidence that people with perceived long-term stress are at increased risk of cognitive decline and dementia,' Solomon agrees. We are in the midst of a panic about what technology is doing to our brains, but as Begeti explains in her book The Phone Fix, the science does not confirm that we are addicted to our phones. That said, she limits checking her Instagram account to twice a day and mutes all WhatsApp groups. 'I suggest people try to develop a routine or a schedule of connection and disconnection that works for them. Distraction is a big thing when it comes to technology. I prefer people to use technology intentionally because they want to, rather than to avoid doing some difficult work or dealing with something, and instead using technology to fill that gap. When people use it as an avoidance tactic, I think that is when it can make them feel bad.' Does having so much information readily available online mean we are losing memory capacity? 'You may not be able to remember a phone number, but the brain is very adaptable,' says Begeti. 'It remembers things that you use and sidelines things that you don't. If you don't remember phone numbers daily, then your brain might not be accustomed to remembering them. It doesn't mean this ability has disappeared. It is more the brain is prioritising certain things that you do.' Maintaining social connections is crucial in helping to avoid dementia. 'Of course, there are problems associated with technology,' says O'Sullivan. 'There is some awful content on there. But I think we often forget the positive things it brings to our lives. For older people, who may not have great mobility, it is creating incredible connectedness.' Begeti adds: 'There are early studies with preliminary findings that show if middle-aged adults engage in social media, they have reduced incidence of dementia.' 'Brain and mind health is all about having ambitions and interests outside of yourself,' says O'Sullivan. 'I have so much work to do that my mind is kept well occupied, but my plan going forward is to do all the things I wish I had time to do now: go back to university, do art appreciation courses, and challenge myself in settings where I'll be mixing with lots of different people.' Find a 'magnificent obsession', says Dr Richard Restak, a professor of neurology at George Washington University hospital in the US and author of How To Prevent Dementia: An Expert's Guide to Long-Term Brain Health. 'Take up an interest, the earlier in life the better, and do a lot of mental work trying to learn more stuff. You can link it to social interaction, which is very important.' 'You need to exercise the brain every day, particularly with memory,' says Restak. At 83, he is still writing books. What is his secret? 'I think, in my case, it is mostly training the brain. I walk and have a sensible diet, but I'm not cultish about it. If my wife brings back some pastries, I will certainly have one.' What's his training? 'Every day I try to learn a new word,' says Restak. 'The word today is turveydrop – based on a character in [Charles Dickens's] Bleak House – and is someone who is just interested in looking important. If somebody calls you that, it's not a compliment.' He keeps lists of all his daily words to refer back to, if his memory fails him. But don't narrow your training too much, he adds. 'Remembering particular things is only good for the area in which they are applied, so that you become a good crossword puzzler or a great Scrabble player. I lose at Scrabble all the time. I think I've got a pretty good vocabulary, but Scrabble is its own world.' 'Learning is harder when you are older,' says Solomon, 'but it helps as you mature.' He played piano as a child, then took it up again 10 years ago. 'People who play musical instruments are less likely to have cognitive impairment because it is all about using the brain.' The same goes for learning languages. With both, 'You're using very different parts of your brain. If you don't do any of those things, there are whole chunks of your brain that are not really being used.' 'Deafness is one of the characteristics that the Lancet Commission has identified as being an important risk factor for dementia,' says Davenport. 'It's the same for vision. Anything that leads you to less interaction with the outside world is likely to be detrimental.' There is less evidence on the effects of reduced vision, he says, 'but if your vision deteriorates, you're going to stop driving, you may stop going out so much, and all of those things start to lead to social isolation, like deafness. Keep on top of your senses; make sure you can hear and see.' Interestingly, Davenport adds, 'sense of smell is often an early symptom of some of the degenerative diseases. No one is suggesting losing your sense of smell leads to them. It is probably just an early symptom, particularly in Parkinson's disease.' Davenport is a keen cyclist. Does he wear a helmet? 'Absolutely. There is good evidence that helmets do protect you.' He refers to the debate around the effect of repeated head injuries in sports such as rugby and football, and their role in neurodegenerative disease: 'There is still quite a lot to be unravelled about that, but it makes sense to try to protect your head from unnecessary injury. Where you need to be careful, of course, is that we know that physical exercise is very good for people, and therefore you don't want to stop kids playing football. But maybe easing up on heading the ball, which is already happening.' O'Sullivan points out that memory decline starts in your 30s. 'We all are increasingly forgetful over time,' Solomon agrees. Don't worry, he says, if, for example: 'You go upstairs for a jumper, and then you get upstairs and you can't remember what you've gone up there for. That's not a reason to see the doctor.' He says that the difference is obvious between patients who have dementia and those who are experiencing normal forgetfulness: 'When I say to these patients, 'Why have you come to see me?', they turn their head to look at the relative who is with them, because they have no idea why they are there.'
The Guardian
05-04-2025
- Health
- The Guardian
Does the UK have a mental health overdiagnosis problem?
When the health secretary, Wes Streeting, suggested the 'overdiagnosis' of some mental health conditions was a factor in the government's welfare changes, many saw the comments as playing into an unhelpful culture-war stereotype of coddled millennials – and as echoing Rishi Sunak's claim, a year ago, that there was a 'sicknote culture' plaguing Britain's economy. But media coverage of Dr Suzanne O'Sullivan's recent book, The Age of Diagnosis, has amplified and lent credibility to the idea that a diagnosis, in itself, can risk limiting an individual's life prospects. Streeting's comments came amid plans for substantial cuts to personal independence payments (Pip), after the government concluded that the overall bill for disability benefits, which rose by nearly £13bn to £48bn between 2019-20 and 2023-24, was on an unsustainable trajectory. Much of the increase in spending is linked to a huge rise in the number of working-age adults claiming disability benefits linked to mental ill health on a scale that demands a policy response. At the heart of the debate is the question of what has caused this increase and how it could be reversed. In 2002, mental and behavioural problems were the main condition for 25% of claimants. By 2024, the figure had risen to 44%, with more than half (55%) of the post-pandemic rise in disability benefits accounted for by claims primarily for mental health, according to a report by the Institute for Fiscal Studies (IFS) thinktank. The same report found 'compelling evidence that mental health has worsened since the pandemic' and experts agree with this assessment. 'We observe clear trends of increasing mental ill health,' says Dr Darío Moreno-Agostino, who researches population mental health at University College London and King's College London. His team's analysis of longitudinal data, tracking cohorts born in 1970, 1958 and 1946, suggests that fafter the pandemic all three generations reached or surpassed the worst mental health levels in 40 years. 'We don't know exactly the reasons, but there are some clear candidates,' says Moreno-Agostino. 'Socioeconomic adversity is one of the fundamental measures of mental health inequalities. I don't think that there's evidence that this is due to overdiagnosis.' NHS records reveal similarly stark trends. The number of people in contact with secondary mental health services rose by 600,000 between 2019 and 2024 – a 45% increase in five years, according to data from the Care Quality Commission, which said the increase in appointments had not kept pace with this trend. In June 2024, very urgent referrals to crisis teams for adults were 45% higher than just one year earlier. Rates of common mental disorders more than doubled in 16- to 24-year-olds between 2000 and 2019 and have increased more steeply since then. As the NHS has struggled to keep pace, clinicians are witnessing a steady increase in the severity of cases, designated green, amber or red. 'In the past we'd see a mixture of green, amber and red,' says Prof Daisy Fancourt, the head of the social biobehavioural research group at UCL. 'Now it's basically all red cases and a few amber. There isn't actually the space to see the greens.' Fancourt, too, is sceptical that overdiagnosis is at play. 'We're going through extremely difficult times for young people,' she says. 'Poverty, Covid disrupted young people's lives at a critical time, the difficulty securing housing and employment, existential challenges, global strife, climate change. On top of that we have challenges around social media and increased availability of global news.' There are also striking inequalities in who receives a diagnosis, according to a recent study by Prof Susan McPherson, a social psychologist at the University of Essex. The research found there were 12 times as many people with 'undiagnosed distress' (symptoms severe enough to meet clinical diagnostic criteria) as there were people with diagnoses in the absence of clinically significant symptoms, using data from the UK Longitudinal Household Study. The 'overdiagnosed' group was so small, McPherson says, that they were almost excluded from the analysis for statistical reasons. People living with a disability had nearly three times the risk of undiagnosed distress compared with those without a disability and women had 1.5 times the risk of being undiagnosed. Both these groups were also at greater risk of having questionable diagnoses (although in much smaller numbers) highlighting that over- and under-diagnosis coexist in a health system that, the study suggests, is designed around 'patriarchal and ableist concepts of normality'. 'They can be misunderstood in both ways,' says McPherson. 'It suggests that mental health services just aren't geared up to meet their needs.' While her research undermines Streeting's claim, McPherson is critical of an 'over medicalisation' of mental health. 'There's a huge problem out there and we can't make it go away just by saying it's overdiagnosis. But diagnosing it all is not the solution either,' she says. 'The answer is looking at the problem from a more social and economic perspective.' Speaking to experts, a recurring theme is the role of social and economic adversity in mental ill health and the NHS is grappling with how to reflect this at a time of widening inequalities. Social prescribing, which aims to improve the health and wellbeing of patients by connecting them to community resources and activities, has tripled in the last three years. 'A lot of the time when people have milder problems there can be community-based solutions,' says Fancourt, who is running trials of social prescribing for young people on mental health waiting lists and in schools. Participants are offered six hour-long sessions with a link worker, who supports them in taking up hobbies, getting involved in volunteering, sport, social activities or dealing with practical challenges around transport or housing. The concept has faced some criticism, with one study of 6,500 people failing to identify evidence of efficacy and concerns over whether patients might feel dismissed. Fancourt agrees that further research is needed, but said demand for the schemes had been far greater than anticipated. 'It's extremely popular across age groups,' she says. 'It's not a pill, it's not a stigmatising treatment. People are building new identities that are based around their hobbies. It's an asset rather than a deficit-based approach.' There is also a question of how the welfare system has played a role in shaping the public conversation around mental health. 'The way the system has been designed, you're either fit for work or ill,' says Dr Annie Irvine, a lecturer in social policy at the University of York. 'The only part of people's life situation that the welfare system is interested in hearing about and legitimising is the health part,' she adds. 'No matter what other issues you're also dealing with – housing, lone parenthood, domestic violence, relationship breakdown, caring – the only part of that the system has a space for at the moment is the mental distress part.' Irvine is not questioning the legitimacy of people's mental distress. 'This idea of shirkers and scroungers claiming benefits by choice is just not reflected in the research I have done,' she says. However, based on her qualitative research with welfare recipients, she argues that mental health is often not the only significant barrier to employment. 'The barriers to work are much broader than that,' she says. 'To bring those numbers down, you need to look beyond the medicalised explanation for worklessness.' The government's green paper, Irvine says, shows some encouraging signs of recognising this bigger picture. Many are concerned, though, that 'overdiagnosis' is a politically convenient idea at a time when squeezing benefits spending is a priority and when the more ingrained determinants of mental health are difficult to fix. 'Identifying it as an individual crisis of care speaks to a wider political motive,' says Prof Ewen Speed, a medical sociologist at the University of Essex. 'It backgrounds a social crisis of inequality. To talk about this as overdiagnosis is a mischaracterisation of the scope of the problem.'
WIRED
05-03-2025
- Health
- WIRED
An Overdiagnosis Epidemic Is Harming Patients' Mental Health
Mar 5, 2025 12:04 PM Diagnosing patients when there aren't effective treatments to give them can make their symptoms worse, argues neurologist Suzanne O'Sullivan. Photograph: Caiaimage/Martin Barraud If you buy something using links in our stories, we may earn a commission. This helps support our journalism. Learn more. Please also consider subscribing to WIRED Neurologist Suzanne O'Sullivan thinks that modern health care is overdiagnosing people but not necessarily making them healthier—and in fact, that it might be doing more harm than good. In her new book, The Age of Diagnosis , she backs this assertion with some sobering facts. For instance, between 1998 and 2018, autism diagnoses jumped by 787 percent in the UK alone; Lyme disease has an estimated 85 percent overdiagnosis rate, including in countries where it's impossible to contract the disease; and there's still little evidence that many cancer screening programs actually reduce cancer-related death rates. Ahead of her keynote speech at WIRED Health later this month, O'Sullivan spoke to WIRED to talk about the boundaries between illness and health, the nocebo effect, and the dangers of early detection. This interview has been edited for length and clarity. WIRED: You've been a neurologist for nearly 35 years. When did you start seeing this new phenomenon of overdiagnosis? Suzanne O'Sullivan: In the book I write about Darcy, a young lady who came to me with seizures. She's only 24 and she had ten other diagnoses. I'm an epilepsy specialist, and that should mean that I'm only seeing people with epilepsy, but unfortunately seizures are a thing that happen very frequently for psychosomatic reasons. When I started, people came to me with seizures that had a psychological cause. That's all they had. WIRED Health showcases the most exciting and thought-provoking disruptors, scientists, and practitioners making a positive change in how we provide and access health care. Find out more. But over the course of the last ten years, that particular group of patients started to gather a long list of diagnoses. What seems to be happening now is that if you go to different doctors with multiple symptoms, you will get a name for them all. These symptoms always existed, but the naming of them has been detrimental to patients. It's caused them to pay a lot of attention to their bodies and that makes the symptoms worse. That's the nocebo effect. Every week now I see at least one Darcy, a 24-year old with different medical labels. Most of those labels have no treatment and aren't making them better. That's a very concerning trend for me. Why are doctors over-labeling symptoms rather than trying to get to the root cause of the disease? We did have an underdiagnosis problem in the past, particularly with learning or behavioral problems such as autism and ADHD. We didn't recognize people who needed help, so we've been trying to correct that. But we've overcorrected. We have been working on the assumption that the more we diagnose, the healthier you can make the population. That was probably true to a point, but the improvement isn't sustained when you get into the milder end of any disease spectrum. Patients come to us wanting answers. People want to understand why they are the way they are. A satisfying consultation between a doctor and a patient is often one where the patient asks about a symptom and the doctor can explain what it is. I think it's a little bit of a collusion between what patients want and how doctors can satisfy them with labels. The increase in the diagnosis rates for ADHD and autism, in particular, have exploded over the past decade. Is this the result of the shifting boundaries between what we now consider to be health and sickness? That's my concern. Autism has risen from like one in 2,500 people to one in 36 children in the UK and one in 20 in Northern Ireland. That happened because people realized that there must be kids out there who've got milder forms of this, and if we help them, they'll get better. However, what has happened now is that we have a massive increase in autism, and it is not having the downstream effect of making children better. We should be seeing a slightly happier population, but all we're seeing is worse mental health. We did something well-intentioned but there's no evidence that it's working. The reason it's not working is because when you get to the very mild end of a spectrum of behavioral or learning problems, you have a balancing act between the benefit of being diagnosed along with the help you can get, and the drawbacks of being diagnosed, which is telling a child that they've got an abnormal brain. What does that do to a child's belief in themselves? How does it stigmatize them? How does it affect their identity formation? We thought it would be helpful to tell children this, but the statistics and the outcome is suggesting it isn't helpful. You're also worried about another aspect of diagnostics, which is overdetection. One example you give in the book relates to modern cancer screening programs that detect the disease at earlier and milder stages. But so far there's little evidence that these are actually beneficial to patients. Every cancer screening program will lead to some people getting treatment when they didn't need to be treated. That will always be the case. What we're desperately wrangling with is that we want to make sure we keep the number of overdiagnosed people down and the number of people who need the treatment up. However, the more sensitive you make those tests, the more overdiagnosed people you will have. I read in a Cochrane review that if you screen 2,000 women, you save one life, and you over treat somewhere between 10 or 20 women. You're always overtreating way more people than lives you're actually saving. So the suggestion that we should do even more of these tests before we've perfected the ones we have does not make sense to me. I do multiple brain scans a week and so many of them show incidental findings. Even though I'm a neurologist and I see brain scans all the time, I don't know what to make of half of them. We just don't yet know how to properly interpret these scans. We need to pay more attention to detecting symptomatic disease early, rather than trying to detect asymptomatic diseases that may never progress. In some cancers—prostate cancer, for instance—patients can opt for watchful waiting rather than treatment. Should this be the norm for early detection? If you're going to go for screening—and I don't want people not to go for the suggested screenings—you do need to understand the uncertainties and realize you don't have to panic. Of course, the minute you hear there's some cancer cells, the panic kicks in, and you want it out and you want the maximum amount of treatment. But actually, in medicine, a lot of decisions can be made slowly. There are watchful waiting programs. I want to suggest to people that, before you go for the screening, know these uncertainties exist, so that you can decide before the test comes back positive what you think you'd likely want to do, and then you can take time to think about it afterwards, and you can ask for a watchful waiting program. I think one of the solutions would be to call these abnormal cells that we find on screening something other than 'cancer.' The moment you hear that word, people's immediate reaction is to get it out, because otherwise they think they will die of it. Watchful waiting is just something people find hard to do. Hear Suzanne O'Sullivan speak at WIRED Health on March 18 at Kings Place, London. Get tickets at .
